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What’s Changing on the Prescription Drug List? Preferred, Limited and CoverKids Formularies Every year BlueCross BlueShield of Tennessee reviews the Prescription Drug List (PDL) to determine changes based on a drug’s effectiveness, safety, and affordability. While many changes to the PDL occur at the beginning of the year, changes can occur at any time because of market changes including: • Release of new drugs to the market after FDA approval • FDA removal of drugs from the market • Release of new generic drugs to the market The following changes to the PDL for 2017 apply to the formularies listed below: • Preferred Formulary • Limited Formulary • CoverKids Formulary Moving to the Preferred Brand (Tier 2) Effective 1/1/17: • Alphagan P 0.1% drops • Bunavail QL • Butrans Transdermal PA, QL • Combigan • Estrace 0.01% cream • Finacea • Renvela • Striverdi Respimat • Trulicity • Viibryd Moving to the Non-Preferred Brand (Tier 3) Effective 1/1/17: • • • • • • • • Androgel 1.25 G, 25 mg & 50 mg (1%) gel PA Astepro Benicar ST Benicar HCT ST Crestor Enstilar Foradil Niaspan • • • • • • • Nucynta QL Nucynta ER PA, QL Nuvigil PA Opana ER PA, QL Osphena ST Patanol Pradaxa • • • • • Premarin cream ST Trintellix Utibron Neohaler Vagifem ST Zenpep 5K-17K-27K Moving to Non-formulary Status (Excluded From Formulary) Effective 1/1/17: • • • • • • • • • • • • • • • • • • • • Aczone 5% gel Adderall XR Alocril Alodox 20 mg kit Alomide Alrex Atralin Azopt Benzaclin Bepreve Betimol Betoptic S Brand prenatal vitamins Concerta Cosopt PF Daytrana Detrol LA Differin 0.1% cream Differin 0.3% gel Dovonex • • • • • • • • • • • • • • • • • • • • Duac Elestat Emadine Enablex Exelon patch Flector patch Fluoroplex Focalin Focalin XR Hpr/Hpr Plus foam, cream Hpr Plus Hydrogel Hpr Plus MB Hydrogel Hylatopic/Hylatopic Plus foam, cream Istalol Lastacaft Limbrel Mb Hydrogel Metadate CD Metrogel 1% topical gel Moviprep • • • • • • • • • • • • • • • • • • Multigen Nivatopic Plus cream Noritate Pramosone E Prepopik Protopic Quillivant XR Ritalin LA Simbrinza Solaraze Sorilux Tobradex ointment Tobradex-ST Vasculera Vectical Victoza Voltaren gel Zylet Changes to the BlueCross Specialty Drug List Effective 1/1/17: Additions: • Cosentyx PA, SPRx • Kitabis Pak QL, SPRx • leuprolide SQ PA, SPRx Deletions: • Glatopa • TobiPodhaler Changes to Prior Authorization Requirements Effective 1/1/17: • Prior authorization required for all long-acting opioids Changes to Quantity Limitation Requirements Effective 1/1/17: • Diabetic test strips ..................................... .......................................................................................................................................................................... 102 strips/30 days • Short-acting beta agonist inhalers (ProAir HFA/ Respiclick, Proventil HFA, Ventolin HFA, Xopenex HFA)................................ 2 inhalers/30 days Changes to Step Therapy Requirements Effective 1/1/17: • Non-preferred diabetic test strips .......................Requires trial and failure of Bayer® (Contour/Breeze2) or Lifescan® (One Touch) test strips • Osphena, Premarin cream, Vagifem ..............................................................................................................Requires trial and failure of Estrace 0.01% cream Changes to the 2017 Affordable Care Act (ACA) $0 Copay Contraceptive List Effective 1/1/17: Additions: • Larissia Deletions: • Ortho Tri Cyclen Lo • Ovcon-35 Changes to the 2017 Affordable Care Act (ACA) $0 Copay Preventive List Effective 1/1/17: Deletions: • Iron supplements Changes to the 2017 Blue Cross High Deductible Health Plan (HDHP) Preventive List Effective 1/1/17: Additions: • Aptiom • Fycompa tablets • Humulin R U-500 • Kaitlib FE • Larissia • molindone • Novolog Flexpen • olmesartan medoxomil • olmesartan medoxomil -hctz • Pulmicort Flexhaler • rosuvastatin • roweepra • Spritam • Stiolto Respimat • Striverdi Respimat • trimiprimine • Trinessa Lo • Vienva • Viibryd Deletions: • Foradil • Glatopa • Victoza Tier Changes: • Pradaxa (Moving to Non-Preferred Brand) Legend: PA – This drug requires prior authorization. ST – Requires other selected drugs to be tried first. QL – This drug has quantity limits on amount covered. SPRx – Specialty drug; many plans require you to get this type of drug from a Preferred Specialty Pharmacy. 1 Cameron Hill Circle | Chattanooga, TN 37402 | bcbst.com BlueCross does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. For TDD/TTY help call 1-800-848-0299. Spanish: Para obtener ayuda en español, llame al 1-800-565-9140 Tagalog: Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 1-800-565-9140 Chinese: 如果需要中文的帮助,请拨打这个号码 1-800-565-9140 Navajo: Dinek’ehgo shika at’ohwol ninisingo, kwiijigo holne’ 1-800-565-9140 (9/16) Whats Changing List Flier